Work

Coronary artery calcium scoring in 2026: strengths, limitations, and optimized clinical use

Year: 2026

Type: article

Abstract: Coronary artery calcium (CAC) scoring on non-contrast ECG-gated CT remains a robust, reproducible marker of total coronary atherosclerotic burden with clear prognostic value and consistent risk reclassification beyond contemporary clinical calculators. Recent studies (2018-2026) reinforce the 'power of zero' for near-term risk de-escalation, identify very high CAC (≥1,000) as a distinct, very-high-risk phenotype, and, importantly, provide randomized evidence that CAC-guided treatment reduces plaque progression. Advances in artificial intelligence (AI), spectral CT, and standardized reporting (SCCT/STR; CAC-DRS) expand opportunities for automated and incidental CAC detection. This mini-review summarizes updated strengths, limitations, and practice guidance; synthesizes new evidence (2024-2026); and includes a practical clinical decision flowchart for the selective use of CAC in prevention pathways.

Source: Frontiers in Radiology

DOI: 10.3389/fradi.2026.1822303

Authors: Pierre Sabouret, Domenico Mario Giamundo, Julien Rosencher, Stefano Figliozzi

Institutions: Sorbonne Université, Policlinico Casilino, CHU Ambroise Paré, Humanitas University, IRCCS Humanitas Research Hospital

Language: English

Topic: Cardiac Imaging and Diagnostics

Subfield: Radiology, Nuclear Medicine and Imaging

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,353